Abstract:
Background
Low adoption of effective health technologies increases illness morbidity and mortality worldwide. In the
case of malaria, effective tools such as malaria rapid diagnostic tests (RDTs) and artemisinin-
combination therapies (ACTs) are both under-used and used inappropriately. Individuals’ confidence in
RDTs and ACTs likely affects the uptake of these tools.
Methods
In a cohort of 36 households (280 individuals) in Western Kenya observed for 30 months starting in June
2017, we examined if experience with RDTs and ACTs changes people’s beliefs about these technologies
and how those beliefs affect treatment behavior. Household members requested a free RDT from the
study team any time they suspected a malaria illness, and positive RDT results treated with a free ACT.
We conducted annual, monthly, and sick visit surveys to elicit beliefs about the accuracy of malaria RDT
results and the effectiveness of ACTs. Beliefs were elicited on a 5-point Likert scale from “very unlikely” to
“very likely.”
Results
Over the study period, the proportion of survey respondents that said a hypothetical negative RDT result
was “very likely” to be correct increased from approximately 55–75%. Controlling for initial beliefs, people
who had been tested at least once with an RDT in the past year had 3.6 times higher odds (95% CI [1
1.718 7.679], P = 0.001) of saying a negative RDT was “very likely” to be correct. Confidence in testing is
associated with treatment behavior: those who believed a negative RDT was “very likely” to be correct
had 1.78 times higher odds (95% CI [1.079 2.934], P = 0.024) of adhering to a negative RDT result (by not
taking ACTs) than those who were less certain about the accuracy of negative RDTs. Adherence to a
negative test also affects subsequent beliefs: controlling for prior beliefs, those who adhered to their
previous test result had approximately twice the odds (OR = 2.19, 95% CI [1.661 2.904], P < 0.001) of
saying that a hypothetical negative RDT was “very likely” to be correct compared to those who did not.
Conclusions
Our results suggest that greater experience with RDTs can not only increase people’s confidence in their
accuracy but also improve adherence to the test result.
